Brain & Spine

An aneurysm, from the Greek word meaning dilation, is an enlarged spot on an artery. It is caused by blood pressure pushing out a weakened spot in an artery wall, forming a bulge.

Aneurysms can occur in your chest (thoracic), stomach area (abdominal), brain (cerebral), and legs (peripheral).

The danger of an aneurysm is that it could rupture or dissect (meaning that the walls of the artery could splinter). In these cases, blood loss can be severe, dramatic, and rapid.

Symptoms

You may go for years — your whole life — not even knowing you have a weakened artery wall. However, if your aneurysm grows — or ruptures — you will develop symptoms that differ depending on the area in which the aneurysm exists.

Brain (cerebral):

• Pounding, sudden, severe headache
• Blurred vision
• Pain behind one eye
• Dilated pupil
• Numbness in one side of the face
• Paralysis

Nausea and vomiting combined with a sudden, intense headache indicate an emergency. If a brain aneurysm ruptures, you will feel lightheaded from your blood flow drastically slowing down, have low blood pressure with an increased heart rate, and you can go into shock.

Chest and stomach (thoracic and abdominal):

• Sharp pain in your jaw, neck, back, chest, or abdomen
• Irregular heartbeat
• Shortness of breath Hoarseness or trouble swallowing
• Clamminess
• Nausea or constipation
• Lightheadedness

Leg or other (peripheral):

• Weakness in the affected area
• Pain or swelling
• Discoloration

Any ruptured aneurysm is an emergency, because the internal bleeding and subsequent drop in blood pressure can bring on shock, where your internal organs are not receiving the oxygen and nutrients they need to function.

Causes

An aneurysm might be present at birth, or one might develop in an already-weak area as a result of disease or injury.

Those over 55 are more likely to develop an aneurysm. Factors that you can control, however, are tobacco and illegal drugs; use of these substances puts you at higher risk. High blood pressure and atherosclerosis (hardening of the arteries because of plaque build-up) also put you at risk. Family history can be an indicator as well.

Living better

If you have an aneurysm, your best course of action is to do as much as possible to keep your blood vessels healthy. That means stop smoking (if you do), eat a healthy diet that prevents the buildup of bad cholesterol, control high blood pressure if you have it, and exercise moderately. You may benefit from incorporating relaxation exercises and meditation into your daily routine.

If you have experienced functional loss or impairment as a result of a brain bleed, you may want to enlist the help of the physical, occupational, and speech therapists on your team to help regain your abilities.

Your physician at St. Luke’s might also recommend that you go in for regular screenings, perhaps ultrasounds (depending on the location of the aneurysm) to make sure that the aneurysm stays in check.

Exams and tests

At St. Luke’s Center for Neuroscience, your physician may use any of several tests to check for the presence, precise location or extent of a suspected aneurysm. A thorough physical exam will be performed and your complete medical history, including family information, will be taken down. Abdominal and chest aneurysms have a higher rate of being hereditary. Your doctor will ask specific questions regarding any symptoms you have and how long you’ve had them.

Additional tests performed may depend on the pain or other symptoms you’ve been experiencing and the location of the site. An ultrasound or echocardiography can detect the presence and size of an aortic aneurysm. A computed tomography (CT) scan, with or without dye, conveys similar information in a more detailed way. Magnetic resonance angiography (MRA) and magnetic resonance imaging (MRI) scans help to pinpoint the details, and are important alternatives to CT scans that reduce exposure to radiation for patients who receive frequent screenings. An angiography can show the insides of your arteries and give your physician a better understanding of their condition.

If a brain aneurysm is suspected but a CT scan does not show bleeding, your physician may elect to perform a cerebrospinal fluid test. Brain aneurysms can rupture in spaces between the brain and the tissue that protects it, resulting in something called a subarachnoid hemorrhage. This test checks for the appearance of red blood cells in your fluid, which would indicate the aneurysm.

There are also other, more detailed tests that your doctor may choose to perform if more information is needed or the conventional tests do not yield enough data.

Treatments

The treatment plan you and your team at St. Luke’s Center for Neuroscience arrive at will depend on your age and medical history, the size and location of the aneurysm and any symptoms you are experiencing.

The primary goal is to keep the aneurysm from rupturing or dissecting. If you have an aortic aneurysm below a certain size, your doctors may just want to do routine testing using ultrasounds to make sure it doesn’t grow. However, if indicated, treatment of an aneurysm can include surgery.

A tumor is a mass or growth of abnormal cells. Cells like these don’t receive signals to turn off, or stop growing, so they keep multiplying. Though there are more than 100 kinds of brain tumors, they are divided into two basic types.

Primary tumors start in the brain. They can be malignant or benign.

Secondary tumors are also known as metastatic tumors. These are tumors that have spread from cancer in another part of your body. In some cases, you may not even be aware of the cancer until it reaches the brain. Secondary tumors are generally malignant and cancerous.

Brain tumors can affect both children and adults. According to the National Brain Tumor Society, about 75,000 patients receive a primary-site diagnosis each year in the United States; a mid-range estimate of patients who have a metastasized brain tumor is about 200,000.

Symptoms

Symptoms of brain tumors depend on the type, size and location of your tumor. As the tumor grows and puts pressure on different areas, your symptoms may change.

• Headaches
• Seizures
• Vision problems
• Memory loss
• Confusion
• Behavior and personality changes
• Vomiting

Causes

There is no known cause for the development of a primary brain tumor. There are some risk factors: brain tumors are more common as we age, and if you have had exposure to radiation, especially in the area — for example, radiation therapy for another cancer — you are more at risk.

Secondary tumors, which spread from other cancers, have a few known sources. About half of all brain tumors have metastasized from lung cancer. Other cancers that might spread to the brain include breast, colon, and kidney cancers, as well as melanoma.

Living better

If your tumor affects the part of your brain that controls speech, you may want to see a speech therapist; or, if motor control becomes an issue, you may enlist help from a physical or occupational therapist. Rehabilitation efforts may be temporary while you learn new ways to do things, or you may want to work with support professionals for a longer period of time.

Emotional support is key. Find a therapist, psychologist or psychiatrist who can work with you to navigate. There might be a support group available in your area as well; social workers can help you make the right connections.

Exams and tests

Your physician at St. Luke’s Brain & Spine Tumor Center will take a complete medical history, including a family history. During your physical exam, you’ll be checked for any possible lumps, and you’ll answer questions about your health habits. A neurological exam would include tests and questions that check both your brain functions and coordination, as well as how your muscles and reflexes work.

Another exam that could be administered is one regarding your field of vision. And if your family has a history of brain tumors, your doctor may do genetic testing to look for an inherited condition.

Computed tomography (CT or CAT) scans and magnetic resonance imaging (MRI) scans can be used to isolate the location of a tumor. If a brain tumor is found, positron emission tomography(PET) scan may be performed as well. This test determines if there is cancer present in any other part of your body. Once an initial diagnosis is confirmed, a biopsy may be taken.

Treatments

The type of treatment depends on your age (adult or child); your medical history; the type, location and size of the tumor; whether it is benign or malignant; and whether it is primary or the result of a cancer that has metastasized.

Surgery

Though surgery is often considered last when treating other conditions, it may be the best line of defense when treating a brain tumor, depending on its location in the brain. St. Luke’s is the first in the region to be able to perform laser interstitial thermal therapy (LITT), a procedure that uses minimally invasive MRI-guided laser technology to target and destroy cancerous brain tumors. With this advanced laser technology, it is possible to reach some tumors previously considered inoperable.

GammaTile Therapy

St. Luke’s is first in Pennsylvania to offer GammaTile Therapy, a surgically targeted radiation therapy for operable brain tumors. GammaTile is a biocompatible, permanent collagen tile implant that delivers radiation therapy to the area where the brain tumor was removed. After the neurosurgeon has safely removed as much of the tumor as possible, GammaTiles are placed in the operative bed, covering the tumor cavity. Once placed, the GammaTiles immediately begin delivering a uniform dose of radiation to the targeted area. GammaTile can eliminate the need for traditional repeat radiation treatments.

Chiari malformations are structural defects that occur at the base of the skull, at the back of the head. These malformations range in severity. The condition occurs when the cerebellum, the part of the brain that controls balance, memory and cognition, slips or partially slips into the opening in the brain where the spinal cord passes through. This misalignment puts pressure on the cerebellum and it blocks, or interferes with the flow of cerebrospinal (CS) fluid.

Symptoms

Symptoms vary to begin with and may change depending on the amount of compression of surrounding tissues and nerves and the buildup of cerebrospinal (CS) fluid. There are four categories of Chiari malformations.

Type I: The most common type, it is possible that no symptoms are experienced at all. If symptoms do develop, a severe headache, especially after sudden movement (coughing or sneezing, for example), is the most predominant; you might also experience neck pain, hearing and balance problems, and vomiting.

Type II: Both the cerebellum and the brain stem tissue protrude into the space opening where the spinal cord enters. Infants may have difficulty swallowing, excessive drooling, a weak cry, breathing problems, arm weakness, developmental delays and an inability to gain weight.

Another condition, called myelomeningocele, is often associated with type II malformations. This is a form of spinal bifida. Other related conditions are syringomyelia and tethered cord syndrome. Types III and IV are rare and severe.

If your infant is showing any of the symptoms of a Chiari malformation, which can be life-threatening in some cases, call your physician immediately.

Causes

Chiari malformations found in infancy are thought to be a result of a genetic mutation that takes effect during fetal development. A maternal diet that lacks certain nutrients is also an influence. Research is being done on exact causes.

If symptoms develop later in life, they can still be the result of a more minor or type I Chiari malformation from birth, or they might be the result of an injury or infection that affects this area of the brain and causes the change.

Living better

If you have been diagnosed with a Chiari malformation, but do not have any symptoms, it is likely that your physician will want to continue to monitor your condition for any progression. The test most generally used to track any changes would be magnetic resonance imaging (MRI) scans performed at certain intervals.

If you or your child has had surgery to correct the condition, you will be making follow-up visits to make sure that the flow of cerebrospinal fluid has been restored. Imaging tests will be performed to check on surgical results and healing.

There may be a support group in your area for people who are living with this condition, or who have a child in whom the condition or related conditions have been diagnosed. Meeting with knowledgeable professionals and with others in circumstances similar to yours can help ease anxiety and provide information or insights on managing symptoms or negotiating setbacks.

Exams and tests

Even though this is a condition that is most severe if diagnosed at birth, there is as yet no pre-natal testing available. Some malformations can be seen during ultrasound. If an infant is born with spinal bifida, testing for a Chiari malformation will be performed.

Your physician at St. Luke’s will use a number of tests, including a physical exam, to determine what is causing your or your child’s symptoms. A magnetic resonance imaging (MRI) scan is the test most often used, as it will produce a three-dimensional image or two-dimensional slice of the tissues, organs, bones and nerves in the affected area. Bone abnormalities most often associated with a Chiari malformation can be seen by X-rays, although the tissue malformation itself will not be seen by these tests. A computed tomography (CT) scan can show evidence of any hydrocephalus or bone abnormalities.

If it is you or an older child who is symptomatic, your physician will also be able to employ tests that measure functions controlled by the cerebellum, which include memory, cognition and balance. Functions controlled by the spinal cord — which include touch, reflexes, sensation and motor skills — can also be evaluated in older patients.

Treatments

Even if a Chiari malformation is found during testing for another condition, no treatment for it is necessary if you are not experiencing any symptoms. Your physician will likely want you to be monitored for any growth or change in the condition. If you have symptoms such as headache or neck pain, simple pain relief medications might be prescribed.

In most cases, the only remedy for severe symptoms that result from this condition is surgery. If the condition is caught during a routine pregnancy ultrasound, there has been success, according to the National Institutes of Health, with prenatal surgery that repositions the spinal cord and closes up the opening in the back of the neck. The goal of this surgery would be to restore the cerebellum and brain stem to a more normal alignment, preventing severity of symptoms and the occurrence of other conditions, including hydrocephalus.

The disks in your spine are donut-shaped structures filled with a jelly-like substance. They are sandwiched in between each of the vertebrae of your spine and act as shock absorbers, making it easy for you to move, twist, bend, and reach without pain.

When you have degenerative disk disease, these small but important structures have started to deteriorate. Sometimes it’s because they’re losing fluid, so they become thinner and less shock-absorbing. Sometimes the disk cracked, bulged, or ruptured — often called a “herniated” disk. Additionally, you may develop bone “spurs” as the vertebrae touch, which put more pressure on the spinal nerve roots.

Symptoms

Because the disks have shrunk in some way, becoming less effective — or because they’ve bulged and are now abrading and interfering with other spaces — your symptoms might include:

• Pain
• Numbness or tingling in the area linked to the section of the spine affected by the degenerating disk
• Weakness related to that area
• Radicular symptoms — pain that radiates from the affected area, along the spinal nerve root, to your arms, hands, legs, or feet

Degenerative disk disease can occur to any of your disks. It is generally seen in the cervical (neck) and lumbar (lower back). Because the lower back supports almost all of your weight, it is often the area in which disk degeneration is first felt.

Causes

One of the primary causes of degenerative disk disease is simply aging.

Smokers are at higher risk for developing this condition, possibly because the chemicals inhaled and the smoke itself result in impaired blood flow to the disk. Those who do heavy lifting, and those who are overweight or obese, are also more likely to develop degenerative disk disease, because the additional weight puts extra pressure on your back muscles and therefore your spine and disks. An injury to the area may also accelerate degenerative disk disease.

If you have osteoarthritis, or spinal stenosis, you are at risk for this condition as well.

Living better

If you’ve been diagnosed with degenerative disk disease, you’ll want to check with your St. Luke’s physician about how to proceed with your daily activities. There may be some motions you need to limit, or exercises you can incorporate to help relieve some of your symptoms. Working with a physical therapist can provide you with an opportunity to learn the best way for you to perform certain movements, as well as find out how to strengthen your abdominal muscles to take more stress off your back.

Exams and tests

Your St. Luke’s physician will take a complete medical history and give you a thorough physical exam. Your doctor will ask you about your symptoms. Some symptoms — such as chills, or fever — might rule out degenerative disk disease and indicate infection; or, you may have both. If you have pain, you may be asked to perform certain motions.

The first test performed is often radiography, which is a type of X-ray; this will show how your bones are aligned. Some tests, such as a magnetic resonance imaging (MRI) scan, may be performed to rule out other possible causes for your pain or numbness, such as metastatic cancer, pancreatic cancer, or an aortic aneurysm.

If these tests don’t provide enough data, your team may decide to use discography.

Treatments

At St. Luke’s, your team of neurologists, neurosurgeons, orthopedic surgeons and physiatrists will work with you to determine the course of treatment that would be best for you.

Medicines, including pain relievers and anti-inflammatories, might be the first line of defense. Anti-convulsants have sometimes been proven to be helpful if you have pain that radiates from your spine to an extremity.

If surgery is indicated, neurosurgeons at St. Luke’s can rely on a number of leading edge techniques, including minimally invasive treatments. Surgery generally has one of two purposes: to either remove the disk and replace it, stopping the pain from being generated, or to eliminate pain by stopping motion in the affected area.

Another treatment available at St. Luke’s is a minimally invasive surgery performed to relieve chronic and intractable back pain. A neurostimulation device — an electrode — is implanted on the spine; it is used to halt transmission of pain signals to the brain.

The experts on your team at St. Luke’s will help you make the best decision for your health.

Hydrocephalus refers to a condition in which the cerebrospinal fluid that surrounds, protects and nourishes the brain is unable to drain, resulting in a buildup that causes the ventricles (cavities) in the brain to become enlarged.

“Normal pressure” refers to the fact that, in some cases, this buildup occurs without changing the normal intracranial (within the brain) pressure.

Symptoms

NPH is generally distinguished by the presence of three specific symptoms. These symptoms do not always appear simultaneously and can be present in varying degrees.

• You may have differences in the way you walk. Because the condition can interfere with your balance, you may adopt a wide-based, short-stepped walk, as if you are shuffling. You may also find yourself unable to walk or stand.
• You may exhibit signs of mild dementia, becoming forgetful and disinterested in daily activities, and having difficulty performing ordinary tasks.
• You may experience greater urgency or frequency to your urinary habits, or you may become incontinent.

These symptoms are sometimes seen as indicators of Parkinson’s or Alzheimer’s disease, or even of normal aging.

Causes

The cause for primary NPH — with no other symptoms or conditions — is unknown. Secondary NPH — when the condition is the result of something else — can be caused by something that happens to your head or brain: an injury or surgery, a hemorrhage or infection, a tumor or cysts.

Living better

The most important thing about normal pressure hydrocephalus is to get the correct diagnosis so that your symptoms can be evaluated properly and treated. Early diagnosis and treatment often results in improvement or resolution of symptoms.

With this condition, you may be coping with physical limitations such as slow or unsteady walking, urinary issues and other problems that make social interactions upsetting or difficult. A physical therapist can help you find ways to achieve better balance, and an occupational therapist can help you figure out solutions to any daily tasks that have become difficult.

Exams and tests

At St. Luke’s Center for Neuroscience, your physician will perform a thorough physical exam and ask you specific questions about the symptoms you’ve been having and how long you’ve had them. The most usual test to administer is a magnetic resonance imaging (MRI) scan, whose three-dimensional images can show your health care team what is happening to the tissues and structures of your brain. A computed tomography (CT) scan might also be used.

Other tests, more specific to this condition, are those that involve measurement of your cerebrospinal fluid. These tests can be performed in various ways, including intracranial pressure monitoring and lumbar puncture.

Treatments

If your symptoms are mild, your St. Luke’s physician may decide to monitor your situation; you may experience no increase in degree.

If your symptoms are or become moderate or severe, the general solution for this condition is to find a way to get the cerebrospinal fluid to drain. This involves surgery.

Before surgery, your physician may want to do a test to find evidence that it will reach the intended goal. To this end, your gait may be tested; a spinal tap done to drain excess fluid; and then your gait is tested again. This way, your symptoms could be measured before and after the drainage to see if it has achieved the desired result.

A cerebral shunt may be recommended to relieve pressure on the brain caused by fluid accumulation. Another minimally invasive procedure is called endoscopic third ventriculostomy.

If you are not a candidate for surgery, your physician may treat you with medicine that can help alleviate some mood or behavior issues that have been brought on by the condition. You may see occupational or physical therapists for help with daily tasks or walking.

A tumor is an abnormal group of cells.

A pituitary tumor, therefore, is an abnormal group of cells that grows in your pituitary gland. Nearly always benign — meaning not cancerous, and unlikely to spread to other organs — tumors in this gland can present problems in two ways. It can influence your body’s production of certain hormones; this is known as a functional pituitary tumor. Or, it may be a non-functional pituitary tumor, not making enough of any particular hormone to cause a hormonal problem, but growing too large and putting pressure on the parts of the body around it.

Sometimes these tumors are so small that their presence is undiagnosed. In fact, a pituitary tumor is often only found by chance, during tests for other conditions. According to the American Cancer Society, about 10,000 are diagnosed in the United States every year.

Symptoms

The pituitary gland affects the hormones that control your growth, metabolism, fat build-up, ovulation, milk production and childbirth contractions, testosterone and sperm production and kidney function.

If the tumor is non-functional— not producing or stopping hormone growth — but still large enough to affect either the gland itself or other areas, from pressure, you may experience:

• Headaches
• Some vision loss
• Loss of body hair
• Decrease in sex hormones (fewer or no periods in women, less facial hair in men, for example) and sex drive
• In children, slower growth and development

If the tumor is functional, your symptoms will depend on which hormone production is affected.

If the thyroid hormones are affected — those that control your metabolism — you may experience unexplained weight loss, a rapid or irregular heartbeat, nervousness, and excessive sweating.

Causes

The cause of pituitary tumors is unknown, although the condition is mostly seen in older adults. A small percentage of cases can be attributed to family history; a genetic component is being further explored.

Living better

Once you’ve been diagnosed with a pituitary tumor, your physician will probably need to monitor your symptoms on a scheduled basis. It’s important to follow any medicine regimens that may have been put into place, for they will help regulate any affected hormones. Your hormone levels will be periodically checked, as well as general pituitary function.

If you’ve had surgery or radiation, there will be certain protocols that you will probably follow for the rest of your life, to make sure that the tumor is either fully gone or controlled. Your vision will probably be checked as well, to make sure that your optic nerve is fully functional.

Exams and tests

Often asymptomatic and therefore undiagnosed, these tumors are sometimes found during tests for other conditions. If you are experiencing any of the symptoms associated with a pituitary tumor, your physician at St. Luke’s will do a thorough physical examination and ask you about any changes you may have noticed in your body. A family history will be taken as well.

Blood and urine tests can show the under- or over-production of certain hormones. Brain imaging — a computed tomography (CT) or magnetic resonance imaging (MRI) scan — might be given to determine if a tumor is present and find out its size.

Vision testing will be performed, especially if you are reporting impaired direct sight or peripheral vision. A neurological exam, checking your coordination, reflexes, and muscle function may also be administered.

Treatments

The treatment recommended by your physicians at St. Luke’s will depend on your age and overall health, the size of the pituitary tumor, its type, and how far it is impinging on parts of your brain. If your symptoms are not problematic, your doctor may prefer to wait and simply monitor the condition.

Medicine may block or correct excess hormone production; some medicines can shrink certain tumors. If your tumor is pressing on your optic nerves, or causing an overproduction of certain hormones, surgery may be the best solution. At St. Luke’s, if the tumor is small enough, surgery can be performed as an endoscopic procedure.

Radiation therapy may be used after surgery to kill any remaining tumor cells. If the tumor is removed, hormone replacement therapy may be needed in order for you to maintain normal levels of whichever hormone has been affected.

A spinal cord injury is not really a single event; there is initial force, which can damage the spinal cord and nerve cells. After that, compression, loss of oxygen and the release of toxic chemical at the site continue the damage.

According to the National Spinal Cord Injury Association, there are about 450,000 people with a spinal cord injury living in the United States. There are about 8,000 new diagnoses each year, more than 80 percent between the ages of 16 and 30, and 75 percent male.

Symptoms

The symptoms you experience with a spinal cord injury depend on both the severity of the injury and its location. Different parts of the spine send signals to different parts of the body. The higher in the spinal cord the injury, the more function is lost.

There are two overall areas that are affected. One is movement, as your spinal cord delivers messages from your brain to your muscles. The other is sensation, as the spinal cord itself enables you to feel, touch, and experience heat, cold, and pain, as it sends signals back to the brain.

Someone who has all or part of the trunk, legs, and pelvic organs affected is said to have paraplegia. The terms quadriplegia or tetraplegia refer to the condition of having those areas, plus the arms and hands, affected.

Taking all this into account, immediate symptoms can include:

• Loss of movement
• Altered or lost sensation (no feeling, or unable to recognize heat or cold)
• Loss of bladder or bowel control
• Spasms
• Pain
• Difficulty breathing

If, after an accident or injury, you are or someone else is experiencing weakness, lack of coordination, numbness, or paralysis, get immediate medical attention. Extent of injury is not always evident, as swelling or bleeding may occur slowly around the spinal cord. Always assume that a trauma will cause an injury, and call 911. The time between injury and treatment is critical.

If you or someone else has a back or neck injury or accident:

• Don’t move them!
• Call 911.
• Keep the person still.
• Hold or brace head and neck to prevent movement.
• Provide basic first aid without moving head or neck.

Causes

Most spinal cord injuries are the result of trauma. In the United States, motor vehicle accidents are responsible for almost half of all new spinal cord injuries each year, with falls — in those over 65 — representing another 15 percent. Violent crimes, including gunshots or knife wounds, account for 12 percent, with sports and recreation (impact sports and diving, for example) another 10 percent.

Overwhelmingly — 80 percent — of spinal cord injuries are experience by males, and most are between 16 and 30. In cases where there is no trauma, the injury can be caused by arthritis, cancer, inflammation, infection or disk degeneration — all conditions that can cause compression of the nerves of the spinal cord.

Living better

After a spinal cord injury, there are many issues that need to be addressed depending on the extent of the injury and its location. At St. Luke’s, you will work with a team that includes physical and occupational therapists, rehabilitation nurses and psychologists, physiatrists, neurologists and social workers.

You may need to employ a caregiver. There may be medications to help your circulation and breathing, to regain or improve bladder, bowel and sexual function, and to control any pain. You will need to learn how to maintain and strengthen your body, from food to exercise, to prevent complications, and possibly relearn fine motor skills using adaptive techniques. You may want to install modifications such as ramps, grab bars and levers instead of doorknobs for easier turning, and need to use prosthetic devices that are computer or voice controlled. Motorized or manual wheelchairs may be necessary.

Exams and tests

In the case of trauma, the physician will first do a visual inspection and then test for sensory and motor function. If you can talk, the doctor will ask questions about the accident and get any information about your medical history, medications and family history. What might seem on the surface to be a minor injury can be much more significant if you have a pre-existing condition such as arthritis or disk degeneration, for example.

A magnetic resonance imaging (MRI) scan is the most helpful test to find bone damage as well as herniated disks, blood clots, and other masses that could be pressing on your spinal cord. Other tests, such as X-rays, can show disturbances to your vertebrae.

Often, a more comprehensive neurological exam is performed a day or so after the trauma, after swelling has a chance to subside. This exam would check for muscle strength and responsiveness to touch and sensation.

Treatments

At St.Luke’s, you will find neurosurgeons, orthopedic surgeons, neurologists, skilled therapists and others who will make up your spinal cord injury team.

Surgery is a front-line treatment for spinal cord injury. It is performed to remove fragments of bone or foreign objects that might be putting pressure on the spine; to stabilize the spinal cord; or to prevent future pain or deformity.

Often, there are secondary problems that result from spinal cord injury after any life-saving treatments have been administered. Muscles need to be reconditioned. Bowel and bladder issues, as well as sexual function, need to be addressed. You may have a respiratory infection or an increased risk of blood clots. Different medicines, exercises and treatments are available to treat these and other conditions.

In spinal stenosis, the space around the vertebrae (bones) of the spine becomes lessened. This narrowing can occur in the space between the bones of the spine; the space at the center of the spine (where the spinal cord nerves run); or the channels where the nerves branch out from the spine. As this happens, the space around the nerve roots gets smaller; also, the compression may prompt the growth of bone “spurs” that breach the spinal canal.

Spinal stenosis is generally found in the lumbar (lower back) region of the spine, which bears most of the weight of your body. It can also be found in the cervical (neck) region, where it can affect more of your body and is therefore more dangerous.

Symptoms

As with other conditions that affect the spine, where your symptoms are felt will depend on where your stenosis has occurred:

• Pain
• Tingling
• Numbness
• Muscle weakness

If your spinal stenosis is in the lumbar region, these sensations will most likely be felt in your lower body and extremities; if in the cervical region, these sensations will cover more territory, including your upper body and extremities as well.

With either, you may feel pain or have difficulty when you are walking or standing that goes away when you are sitting or leaning forward; this is because that extension action opens up the compressed areas.

If you are experiencing bladder or bowel incontinence, problems with sexual function, or severe pain or numbness in one or both legs, talk to your physician at St. Luke’s immediately, as these symptoms indicate a serious condition that needs to be addressed swiftly.

Causes

Spinal stenosis is often associated with other conditions, such as osteoarthritis and scoliosis — diseases that put pressure on the bones of the spine. Herniated (or ruptured) disks can also produce this narrowing of the spinal canal. Adults with Paget’s disease may develop spinal stenosis.

Too much fluoride in your body or calcium deposits on or the thickening of ligaments that support the vertebrae of the spine can also cause spinal stenosis, as can trauma or injury to the area.

Living better

The pain and fragility you feel from spinal stenosis may make you disinclined to get proper exercise. However, your body actually needs the opposite. A physical therapist at St. Luke’s can recommend the exercises you need to strengthen your muscles and help stabilize your spine.

Your doctor may recommend that you lose weight, which can be difficult if you are experiencing limited mobility. Think of weight loss not as eliminating food, but as eliminating stress on your back; it may help you to visualize a path to better overall health.

Exams and tests

Your St. Luke’s physician will give you a thorough medical exam, take your complete medical history and ask about any recent injuries or illnesses. You may be asked to go through certain movements, such as leaning forward, sitting, standing and walking, to see if or when any pain increases or subsides.

An X-ray may be taken, to see if there are any changes to the bones of your spine or if bone spurs have grown. A magnetic resonance imaging (MRI) scan may be performed; this test can show any damage to disks and ligaments, and reveal areas where nerves in the spine may be compressed. A computed tomography (CT) scan that uses an injected dye for contrast can also show this kind of damage.

Treatments

Your team at St. Luke’s will likely include different specialists, depending on the cause of your conditions. The knowledge of any or all of a neurologist, neurosurgeon, rheumatologist, orthopedist, orthopedic surgeon, physical therapist and physiatrist may relied on as a resource.

If your pain or other symptoms are mild, you may be prescribed a course of medicine that will give you temporary relief. Steroid injections, which reduce swelling, may be prescribed. These kinds of injections may relieve pain for a longer period of time, but can only be used a few times a year because they can have a negative effect on surrounding tissue.

At St. Luke’s, minimally invasive procedures are available as solutions, performed by surgeons who are experts in their fields. In one such procedure, called percutaneous lumbar decompression (PILD), part of a thickened ligament in your spinal column can be removed, creating space around the nerve and lessening pressure on the nerve root in the area.

Surgery is a course of action that is used if and when your pain or other symptoms cause you to have a poor quality of life.

A tumor is a mass or growth of abnormal cells. Cells like these don’t receive signals to turn off, or stop growing, so they keep multiplying. A spine tumor is an abnormal growth of tissue along your spinal column, which is the column of nerve tissue surrounded by your backbones (vertebrae).

According to the American Association of Neurological Surgeons, about 10,000 people in the United States develop primary or metastatic spinal cord tumors each year.

Symptoms

Symptoms of a spine tumor are pain, numbness, less sensitivity to cold or heat, and paralysis. An early sign is pain in your back or pain that spreads from your back to your arms and legs. You may experience weakness in your legs or have trouble walking or have changes to your bowel or urinary habits.

If back pain is persistent or progressive, unusual for you or unrelated to any physical activity or injury, see a doctor for a thorough evaluation.

Causes

Causes of primary spine tumors are unknown. Most extradural spine tumors are metastatic; that is, they have spread from cancer in a different area of your body, notably your kidney, breast, prostate or lung. Intradural tumors, which are mostly benign, are less common.

Living better

If you’ve gone through treatment for a spine tumor, your best path to feeling and living better is to make sure you take the proper time to recover and rehabilitate. A physical therapist, working with your team, will help you regain strength.

If your tumor can’t be treated, or you are living with one while treatment is being discussed or evaluated, you may want to reach out to others for emotional support. Relaxation exercises and acupuncture for any nausea that you are experiencing as a result of treatment might be helpful, as will keeping your stress level low.

Exams and tests

Your physician at St. Luke’s Brain and Spine Tumor Center will take your complete medical history and ask specific questions about your symptoms. A physical examination will be performed, as well as a neurological exam that tests your reflexes and senses.

For spinal tumors, a magnetic resonance imaging (MRI) scan is the preferred tool. The three-dimensional images produced can show your neurologist and neurosurgeon the tissue, bone and other areas that might be affected if a tumor is present. If a tumor is found, a biopsy may be performed to get more information about the specific kinds of cells involved.

Treatments

Your St. Luke’s physicians will put together a detailed treatment plan that depends on the tumor, its type and location, any riskr not acting, your age, gender and general health. If your tumor is a primary one, the goal will be to remove it completely, if possible. If your tumor is metastatic, your treatment will depend on the progression of your primary cancer; it may be palliative, aimed at relieving your symptoms and improving your quality of life.

Size, rate of growth, symptoms, and all other factors considered, your team may decide that your best course of action is to monitor the tumor for a while with periodic MRI scans.

Or, if your team decides that intervention is necessary, there are several avenues that might be taken, again dependent on the type of tumor and its location. Chemotherapy and radiation therapy can also be employed. If the tumor proves resistant to either chemotherapy or radiation, surgery can be used.